Quick answer: Track keto progress in several ways. Weigh yourself regularly at the same time of day, measure your waist, and consider body fat estimates from calipers or bioelectrical impedance (BIA). Just as important are non-scale changes: energy, sleep, mood, focus, cravings and exercise performance. Lab tests with your provider can show changes in blood sugar and cholesterol.
Key takeaways
Weighing at the same time each day and watching trends gives a more accurate picture than daily swings.
Body composition tools such as calipers or bioelectrical impedance, along with waist size, tell you more than weight alone.
Energy, strength, sleep and labs such as fasting glucose, A1c and a lipid panel show how keto is affecting you.
Weighing yourself
Weigh at the same time of day, such as first thing in the morning, and look at trends rather than daily swings.
Body composition
Skinfold calipers
Measure skinfold thickness at specific sites and estimate body fat. Accuracy depends on technique.
Bioelectrical impedance (BIA)
Smart scales and devices send a weak current through the body to estimate body fat. Hydration affects readings.
Waist measurement
A simple, useful marker of abdominal fat.
Non-scale changes
Watch for changes in your energy levels, physical performance, strength and recovery, and sleep quality. Shifts in appetite and cravings, mood and focus, and how your clothes fit also tell you a lot.
Lab markers
With your provider, labs such as fasting glucose, A1c and a lipid panel can show how keto affects you. See insulin sensitivity.
Tracking tools
Use macro tracking and ketone testing alongside these measures.
Healthy aging lens
Muscle strength, waist size and metabolic labs tell you more about healthy aging than weight alone.
What the research shows
Studies of keto show that results go beyond weight, including body composition, lipids and fitness.
Six weeks of keto in healthy adults (Urbain 2017, before-and-after study). 42 healthy adults followed a ketogenic diet (about 72% fat, 21% protein and 8% carbohydrate) without calorie limits for 6 weeks. They lost about 2 kg, split equally between fat and lean mass. Peak power dropped 4%, LDL cholesterol rose about 11%, and insulin fell 22%. A limitation is that there was no control group, so changes can’t be fully separated from other factors.
Keto under tightly controlled conditions (Hall 2016, metabolic ward study). 17 men with overweight or obesity lived on a research ward, eating a high-carbohydrate diet for 4 weeks and then a ketogenic diet with the same calories and protein for 4 weeks. Energy use rose a little on keto (about 57 to 151 kcal a day depending on the method), but body fat loss actually slowed, while loss of lean mass increased. A limitation is that there were only 17 men, the diets were not randomized in order, and 4 weeks may be too short to see longer-term adaptation.
Healthy low-carb vs. healthy low-fat (Gardner 2018, DIETFITS randomized trial). 609 adults without diabetes were coached for 12 months on either a healthy low-fat or a healthy low-carbohydrate diet, with both groups told to focus on whole, minimally processed foods. Weight loss was nearly the same (5.3 kg vs. 6.0 kg), and neither genetic testing nor insulin response predicted who did better on which diet. A limitation is that the low-carb group averaged 30% of calories from carbohydrate, so this was not a strict ketogenic diet.
Strength of the evidence: Weight alone can be misleading; studies suggest tracking body composition, waist and labs gives a fuller picture.
When to see a naturopathic doctor
It may be time to see a naturopathic doctor if you have diabetes or take insulin, sulfonylureas or SGLT2 inhibitors (risk of low blood sugar or ketoacidosis), or if you take blood pressure medication or diuretics. The same is true if you have kidney, liver, gallbladder or pancreas disease, or high cholesterol, if you are pregnant, breastfeeding, or have a history of disordered eating, or if you want a keto plan tailored to your labs and goals.
See a medical provider promptly for nausea and vomiting, abdominal pain, confusion, fruity-smelling breath with rapid breathing, or very high blood sugar or ketone readings, which can signal ketoacidosis.
Want a keto plan that’s safe for your health?
A free 15-minute consultation with Dr. Kneessi. No cost, no obligation. In-office in Odenton, MD or by telehealth.
Questions to bring to your clinician
These questions can help you get the most out of your next visit.
Which labs should we check to see how keto is affecting my health?
Which measures beyond weight would show my progress on keto?
Would labs or body measurements give us a better picture?
How often should we review my progress together?
Frequently asked questions
How often should I weigh myself?
Daily or weekly, looking at trends.
Are smart scales accurate for body fat?
They give estimates affected by hydration.
What are non-scale victories?
Changes like better energy, sleep and strength.
Which labs should I check?
Ask your provider about glucose, A1c and lipids.
Sources
- Orsama AL, et al. Weight rhythms: weight increases during weekends and decreases during weekdays. Obes Facts 2014. PMID: 24504358. https://pmc.ncbi.nlm.nih.gov/articles/PMC5644907/
- Dehghan M, Merchant AT. Is bioelectrical impedance accurate for use in large epidemiological studies? Nutr J 2008. PMID: 18778488. https://pmc.ncbi.nlm.nih.gov/articles/PMC2543039/
- Kyle UG, et al. Bioelectrical impedance analysis–part I: review of principles and methods. Clin Nutr 2004. PMID: 15380917. https://pubmed.ncbi.nlm.nih.gov/15380917/
- Ross R, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol 2020. PMID: 32020062. https://pmc.ncbi.nlm.nih.gov/articles/PMC7027970/
- Leong DP, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015. PMID: 25982160. https://pubmed.ncbi.nlm.nih.gov/25982160/
- MedlinePlus: Weight Control
- MedlinePlus: Cholesterol
- Urbain P, et al. Impact of a 6-week non-energy-restricted ketogenic diet on physical fitness, body composition and biochemical parameters in healthy adults. Nutr Metab (Lond) 2017. PMID: 28239404. https://pubmed.ncbi.nlm.nih.gov/28239404/
- Hall KD, et al. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr 2016. PMID: 27385608. https://pubmed.ncbi.nlm.nih.gov/27385608/
- Gardner CD, et al. Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial. JAMA 2018. PMID: 29466592. https://pubmed.ncbi.nlm.nih.gov/29466592/
This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before starting supplements or changing medications, especially if you are pregnant, nursing, or managing a health condition.
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